The burden of HIV-related stigma on clinical and quality of life outcomes: results from a systematic literature review.

Background: HIV-related stigma adversely impacts people with HIV. As part of a systematic literature review (SLR) to evaluate 6 research questions on HIV-related stigma among people with HIV, data from studies examining its prevalence and association with clinical and quality of life (QoL) outcomes are presented. Methods: Searches were conducted in MEDLINE® and Embase® via the OVID platform from May 2020 to May 2023 for prevalence and from database inception to May 2023 for the other 5 research questions. Relevant conferences, SLR bibliographies, and websites were searched from January 2021 to June 2023. Records were independently screened by 2 reviewers until ≥90% inter-rater reliability was achieved. Data were extracted by 1 reviewer and validated by another. Results: The reported prevalence of HIV-related stigma was broad across multiple stigma types and geographic regions, ranging from 11% to 94%. Most identified studies reported significant associations between higher HIV-related stigma levels and reduced HIV-specific healthcare engagement and retention (8/11), suboptimal antiretroviral therapy adherence (16/20), unsuppressed viral load (10/14), high levels of substance use (3/4), and suboptimal mental health (28/30). Most identified studies reported significant associations between higher HIV-related stigma levels and poorer QoL (23/27). Conclusions: The substantial evidence identified by this SLR suggests that HIV-related stigma is a significant challenge for people with HIV and negatively impacts QoL, mental health, and clinical outcomes. These findings underscore the importance of integrating stigma considerations into the dialogue between physicians and people with HIV to foster shared decision-making for treatment and support.